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At least 19 recordsLinked to original sources
PubMed1997

Results of directional coronary atherectomy in Northern New England. Northern New England Cardiovascular Disease Study Group.

The role of directional coronary atherectomy (DCA) in interventional cardiology remains uncertain. We report the Northern New England regional experience with DCA from 1991 to 1994. Data were collected on 11,178 patients having had an intervention on a single lesion in a single vessel (798 DCAs; 10,380 percutaneous transluminal angioplasties [PTCA]). The use of DCA increased from 1.8% of interventions in 1991 to 10% in 1994. Compared with PTCA, DCA patients were younger, more often men, had more 1-vessel disease and more coronary artery bypass surgery (CABG). DCA was more often used in the left anterior descending artery, in vein grafts, for restenoses, for subtotal occlusions, and with type A lesions. Angiographic success (96.7%) and clinical success (93%) were good. Adverse events were rare: mortality 0.9%, emergent CABG 2.2%, nonfatal myocardial infarction 2.8%. After adjusting for case-mix, there was no difference between DCA and PTCA for in-hospital mortality (odds ratio [OR] = 1.03, 95% confidence interval [CI] 0.44 to 2.43, p = 0.95) or need for emergent CABG (OR = 1.27, 95% CI 0.77 to 2.10, p = 0.34). Atherectomy patients were more likely to have a nonfatal myocardial infarction (OR = 2.0, 95% CI 1.26 to 3.20, p <0.01), to sustain an injury to the femoral or brachial artery (OR = 2.89, 95% CI 1.52 to 5.51, p <0.01), and to have a clinically successful procedure (OR = 1.37, 95% CI 1.01 to 1.88, p = 0.05). Our results support the relative safety and effectiveness of DCA as its use disseminated into the region.

Aged↗
PubMed1997

Use of the internal mammary artery graft in Northern New England. Northern New England Cardiovascular Disease Study Group.

BACKGROUND: There is evidence that patients who receive an internal mammary artery graft (IMA) during coronary artery bypass surgery have increased long-term survival. However, an IMA is not used in all patients. METHODS AND RESULTS: We studied the use of IMA grafts among 7944 patients undergoing initial, isolated coronary artery bypass surgery in Maine, New Hampshire, and Vermont from 1992 to 1995. Overall, the IMA graft was used in 82% of patients; of these, 97.2% had left IMA grafts. The use of the IMA graft varied considerably by patient and disease factors. Women received an IMA graft significantly less often (76% versus 85% in men, P<.01). Older patients (> or =75 years) were less likely to receive an IMA graft (67% versus 86%, P<.001). Smaller BSA was also associated with lower rates of IMA grafts in both sexes; however, men and women with BSA <1.8 m2 received an IMA graft at about the same rate. In general, more sick and more urgent patients had lower rates of IMA use. Patients with left ventricular ejection fraction <40% received an IMA less often than those with an ejection fraction > or =60% (77% versus 85%, P<.01). Patients with a greater number of diseased coronary vessels received an IMA more often (one, 78%; two, 82%; three, 85%). IMA use varied significantly by priority of surgery, with elective patients receiving an IMA 88% of the time, urgent 83%, and emergent 51% (Ptrend<.01). The use of the IMA graft varied from 42% to 95% among individual surgeons. Surgeons were consistent in their patterns of IMA graft use for specific risk groups. All surgeons had lower rates of IMA use among older patients, lower rates of IMA among women, and lower rates of IMA use among emergent or urgent patients. However, "low-use" surgeons had consistently lower rates of use within these patient groups. The overall rate of IMA graft use increased from 76% in 1992 to 86% in 1995 (Ptrend<.001). IMA graft use increased in all five centers and in all patient subgroups. The largest increases in use were seen among women (from 69% to 83%), among patients older than 75 years (from 55% to 75%), and in emergent patients (from 40% to 72%). CONCLUSIONS: This regional prospective study of IMA graft use in initial coronary artery bypass surgery describes substantial variability in patient groups receiving an IMA as well as increasing IMA graft use over time. It also suggests that the practice patterns of surgeons are an important determinant of IMA use. These data indicate that even more patients could benefit from the use of this technique.

Aged↗
PubMedDate not supplied

The health effects of ionizing radiation: a survey of local health officials in New England and New York.

The purpose of the study is to determine the educational needs of public health officials concerning their knowledge, attitude, beliefs, and practices with specific reference to ionizing radiation. The public health directors or designates, working in health departments whose jurisdictions fall within a 60-mile radius of the 14 operating nuclear power plants in the New York-New England region, were studied. A review of the literature indicates that historically there appears to have been a limited effort to conduct such a needs assessment in the United States. A questionnaire was developed to measure the public health directors' knowledge, attitudes, and practice. The instrument was mailed in the summer of 1992 to all public officials listed in the National Directory of Local Health Departments. Knowledge, attitude, and practice questions were analyzed in terms of frequency of correct, incorrect, and don't know responses. The data presented convey the message that there should be public input into the risk assessment of nuclear plants and that local health departments should inform the public about the health risks posed by nuclear plants in their locality. The authors recommend that an appropriate Federal agency sponsor a national survey and that States should establish a training program on the health effects of ionizing radiation for local public health officials.

Government Agencies↗
PubMed1996

Indications, practice, and procedural outcomes of percutaneous transluminal coronary angioplasty in northern New England in the early 1990s. The Northern New England Cardiovascular Disease Study Group.

We conducted a prospective cohort study from October 1, 1989 to December 31, 1993 of the current indications, practices and procedural outcomes of percutaneous transluminal coronary angioplasty (PTCA) in Northern New England to determine how it compared with reports from other regions and registries. Thirty-five cardiologists contributed data on 12,232 admissions for PTCA performed at all hospitals in New Hampshire and Maine, plus 1 in Massachusetts, supporting PTCA. Mean patient age was 61.1 years, 67.5% were men, and 38.5% had multivessel disease. Unstable (45.6%), stable (22.9%), and postinfarction angina (21.0%) were common indications for the procedure. Of all patients, 86.9% had 1-vessel PTCA, including 65.7% of those with multivessel disease. Angiographic success was 90.4%, and 88.1% of patients had > or = 1 lesion successfully dilated and no adverse clinical event. The risk of death, nonfatal acute myocardial infarction, or coronary artery bypass grafting was 5.7%. The practice and outcomes of PTCA in Northern New England were somewhat similar to reports from other regional registries but different from a registry of select institutions. We conclude that PTCA as performed in Northern New England is safe and effective.

Aged↗
PubMed1982

Pitfalls in screening for neonatal hypothyroidism. Report of the New England Regional Screening Program and the New England Congenital Hypothyroidism Collaborative.

This report reviews problems encountered during the first five years of operation of the New England Regional Screening Program. Human error was responsible for either overlooked or delayed diagnosis and treatment in 14/159 infants with hypothyroidism. This group consisted of three infants who were never tested, six infants whose diagnosis was missed because of errors during the processing of the blood specimens, and five additional children in whom the diagnosis of hypothyroidism could not be made at birth because the concentrations of thyroid-stimulating hormone were not elevated. Many of the problems, most of which occurred during the first two years of the study, have been eliminated by improved communication and monitoring. This study emphasizes the potential vulnerability of all screening programs and underscores the need for physicians to continue to exercise their best clinical judgement regardless of the circumstances.

Congenital Hypothyroidism↗
PubMed1993

Oral health status of the elderly in New England.

The New England Elders Dental Study (NEEDS) reports the prevalence, extent and severity of oral diseases and conditions among a representative sample of community-dwelling elders age 70 and older residing throughout the six New England states. In-home, full-mouth examinations were conducted by four calibrated dentists who used National Institute of Dental Research (NIDR) standardized disease measures plus additional diagnostic codes on all tooth surfaces. Only 37.6% of elders age 70 and older were edentulous, while dentate elders had a mean number of teeth per person ranging from 21.5 to 17.9 across age and gender cohorts. The prevalence of untreated coronal decay in elders with teeth was 28% in female elders and 34% in male elders. More than 90% of all elders with teeth had coronal fillings and 22% exhibited untreated root caries. Periodontal destruction was substantial, with 66% of dentate elders exhibiting moderate periodontal pockets (4-6 mm) while 21% exhibited severe periodontal pocketing (> 6 mm). Comparisons with national surveys suggest that periodontal disease prevalence and severity appear to have been underestimated in previous national studies of the elderly. Because of aging and tooth retention trends, the periodontal disease problem of the elderly may be increasing in the face of dentists' tendency to underdiagnose the periodontal diseases, legal constraints on dental hygienists to independently treat them, and inadequate funding for conservative nonsurgical therapies.

Aged↗
PubMed1990

Survey of intramammary infections in ewes on the New England Tableland of New South Wales.

Samples of mammary secretion were collected aseptically from 1093 ewes in 8 separate flocks. Most of the ewes were suckling lambs 4 to 6 weeks old. Standard bacteriological tests were carried out on the samples to identify the organisms involved in intramammary infections. Data on age, breed, lactational status and clinical status of the gland and its secretion were recorded at the time of sampling. The prevalence of intramammary infection was 14% of ewes (8% of glands). There was a tendency for prevalence of intramammary infection to be positively correlated with age of the ewe (two-year-old and six-year-old ewes had, respectively, 4.4% and 14.0% of glands infected). This relationship was highly significant for Border Leicester x Merino ewes. There were also significant differences in infection prevalence between breeds. infected glands had a higher prevalence of clinical abnormalities of udder, teat and secretion than did non-infected glands. Staphylococcus aureus was overwhelmingly the most frequently isolated bacterium being responsible for 40% of all intramammary infections.

Age Factors↗
PubMed1996

Data initiatives: HEDIS and the New England Business Coalition.

The New England Business Coalition is a group of 15 health maintenance organizations, large employers, and health care purchasers operating in the New England area. Formally launched in 1994, the coalition's mission is to standardize health care reporting, improve quality, and allow for comparison of managed health care plans for the participating organizations. The National Committee for Quality Assurance (NCQA) and its measurement instrument, the Health Plan Employer Data Information Set (HEDIS) became involved in the coalition's reporting project in 1992 to help the participating plans fulfill their mission of standardization, quality improvement, and comparative evaluation. In the past 5 years, HEDIS has undergone change and development to meet the needs of both health care plans and purchasers who use the HEDIS information to make decisions about health care for employers. Changes enacted within HEDIS have been brought about with the input of HEDIS users such as the New England Business Coalition, a pilot report card project, and a nationally based HEDIS users group. Future enhancements to HEDIS will result in added value for HEDIS users as development and change continue to meet the evolving needs of plans and purchasers.

Databases, Factual↗
PubMed1990

Autosomal dominant familial spastic paraplegia: report of a large New England family.

A large New England family with autosomal dominant familial spastic paraplegia is described. In a pedigree of 173 individuals, 71 affected individuals are identified. Seventeen cases examined by the authors are described with regard to the natural history of FSP in this family. A staging system for following progress and planning interventions is proposed. Three illustrative cases are presented. In this family, FSP is found to have a homogeneous clinical course with nearly complete penetrance. Onset occurs at or before 3 years of age with involvement limited to the lower extremities. After the initial onset, no significant progression was noted. Early aggressive habilitative care may result in more functional ambulation.

Adolescent↗
PubMed1992

A survey of pediatric management of dyslipidemias in New England.

We recently surveyed physicians attending the New England Pediatric Preventive Cardiology Society. Sixteen physicians who actively evaluated children with dyslipidemia completed questionnaires; at least one representative from six of the seven medical schools in New England was included. The survey elicited responses to five hypothetical cases of childhood dyslipidemia which were representative of the types of lipid problems commonly referred to pediatric lipid specialists. Diet modification was the initial treatment of choice of all participants. For any set of lipid values, postpubertal age increased the proportion of respondents who would have prescribed medication. When pharmacologic intervention was elected, resin binders (cholestyramine or cholestipol) and niacin were most commonly prescribed. The responses of the physicians showed considerable variation in the threshold for beginning medications. In summary, this survey suggests substantial variation in the approach to pharmacologic management of pediatric dyslipidemias in the New England region.

Adolescent↗
PubMed1986

The prevalence of paratuberculosis in culled New England cattle.

The prevalence of bovine paratuberculosis in New England was determined to be 18% based on a random survey of abattoir cattle. Six tissues from each of 100 animals were examined by histologic and bacteriologic methods. The cecal lymph node and the ileocecal valve yielded positive cultures most frequently, but isolations were also made from liver, tonsil, colon, and ileum. On the basis of the prevalence data, the economic significance of paratuberculosis to the New England dairy industry was estimated in excess of +15.4 million annually. Field studies identified 25 infected herds in New England. One of the infected herds from Connecticut was sold at public auction, an act which resulted in the dissemination of 95 potentially infected cattle to 28 farms in 8 different states.

Animals↗